The Diagnostic and Statistical Manual of Mental Disorders

A friend handed me an article by Alex Beam, “Who’s Crazy Now?”, that appeared in the Boston Globe (Tuesday, July 28, 2009). It is a criticism of the making of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and relates the usual criticism about the proliferation of medical diagnoses for normal human emotions, habits and bodily functions (e.g. nicotine dependence and premenstrual syndrome, to name two). It makes the very good point that the losers in this trivialization of mental disorders are the truly mentally ill, who would probably love to exchange places with the merely jet lagged or those undergoing nicotine withdrawal.

The article, while criticizing the marginalization of psychiatry as a profession, has inadvertently shown where exactly psychiatry should be headed if it wants to grow in stature with the public. Well, let me amend that. It shows how psychiatry could reposition itself to feel good about itself. Modern psychiatry appears to be largely about status and not about the people truly in need of its services.

The writer says that adding new so-called mental illnesses is “a naked land grab by a profession threatened with marginalization by biochemical research”. Wrong. Biochemical research has not made mentally ill people suddenly well. There is no threat that I can see from biochemical research.

In referring to the last edition of the DSM, published in 1994, blogging psychiatrist Dr. Daniel Carlat has this to say: “The idea was that in 20 years the science would have progressed to where it had hard scientific and biological markers for diagnoses, it just hasn’t happened. … The lack of biological markers to help us diagnose has made us feel in some way inferior to other medical professionals, as if we were not real doctors, because we don’t base our decisions on hard science.”

Modern psychiatry, feel inferior no more. There are no biological markers and there never will be. Mental illness is largely
p-s-y-c-h-o-l-o-g-i-c-a-l. Modern psychiatry has somehow missed this fundamental point. Take some motherly advice: Hold your head up high and as a profession, get back to doing what you should have been doing all along, which is treating people with serious mental disorders, and gasp, even empowering cure in them. Psychiatry is an art, not a science. Enjoy it for what it is and rid yourself of those who are unskilled in the art of understanding human beings. Let them be brain surgeons or neurologists. Psychiatry is needed, but has turned its back on the seriously mentally ill and their families, whose lives are in turmoil.

I briefly followed a blog by a psychiatrist, and stopped, because all he could write about was insurance and billing. I just bet his waiting room is filled with seasonal affective disorder (SAD) patients. If he has time to blog, which many psychiatrists seem to be doing, he is overachieving and hasn’t got time for the people who really need him.